CDC Researchers Blame JUUL for Rise in Teen Vaping


“JUUL’s high nicotine concentration, discreet shape, and flavors could be particularly appealing to, and problematic for, youths.”

Science says vaping is cool. Okay, maybe science doesn’t directly say that, but evidence shows that more and more teens are using e-cigarettes, and teens are cool, so vaping must be cool, right? Unfortunately, public health officials at the US Centers for Disease Control and Prevention disagree. And they’re placing much of the blame for the rise in teen vaping on one company: the Silicon Valley e-cigarette startup JUUL Laboratories.

In a research letter published Tuesday in the Journal of the American Medical Association, researchers at the CDC and nonprofit RTI International’s Centers for Health Policy Science and Tobacco Research analyzed data from retailers across the country and outlined how JUUL’s meteoric rise in popularity may be accredited — at least in part — to its appeal among teenagers. While all e-cigarette brands increased in popularity between 2013 and 2017 because of marketing suggesting that they help people quit smoking, JUUL has become the most in-demand manufacturer of all.

“JUUL’s high nicotine concentration, discreet shape, and flavors could be particularly appealing to, and problematic for, youths,” wrote the study’s authors, led by Brian King, Ph.D., M.P.H., deputy director for research translation in the CDC’s Office on Smoking and Health.

Many teens may initially try e-cigarettes, like those manufactured by JUUL, because they’re seen as safer alternatives to traditional tobacco cigarettes. And JUUL’s sleek, compact design makes the device look like a USB drive, meaning it can easily be slipped into a pocket or concealed in the palm of the hand. Several reports suggest teens easily sneak it into classrooms. Its modular “pod” design also makes it easy for users to refill the nicotine-containing liquid by simply switching out a coin-sized cartridge. Compared to disposable devices with integrated batteries, JUUL’s rechargeable device offers several attractive qualities to many consumers, and the numbers bear this out.

According to the study’s authors, JUUL Laboratories sales increased by a whopping 641 percent from 2016 to 2017. This growth translated to a 515 percent increase in JUUL Laboratories’ share of the e-cigarette market, jumping from just 2 percent of the vape market when the company started to 13 percent in early 2017. The company’s hold on the vape market exploded after that, and as of December 2017, the company controlled 29 percent of e-cigarette sales. This means that almost one out of every three e-cigarettes purchased in the US is a JUUL.

Notably, the study only used purchasing data from retailers, so it was not possible for researchers to determine how old buyers were. The study’s authors did note, though, that previous research has suggested many of these purchases may have been made by consumers under the legal smoking age.

“These sales could reflect products purchased by adults to attempt smoking cessation or products obtained directly or indirectly by youths; a recent analysis found retail stores were the primary location where youths reported obtaining the JUUL device and refill pods,” they wrote.

JUUL podmod starter kit
A JUUL starter pack includes the device, a USB charger, and four pods of different flavored nicotine-containing e-liquid, all for less than $50.

In response to Inverse’s request for comment on the new paper, JUUL spokesperson Victoria Davis did not address the assertion that JUUL products are popular among young people. Davis did emphasize targeting “adult smokers” three times, though:

JUUL Labs is focused on its mission to improve the lives of the world’s one billion adult smokers. Like many Silicon Valley technology startups, our growth is the result of a superior product disrupting an archaic industry — in this case, one whose products are the number one cause of preventable death. When adult smokers find a satisfying alternative to cigarettes, they tell other adult smokers. JUUL Labs has helped more than 1 million Americans switch from cigarettes, and we’re excited about our continued expansion into markets outside of the United States such as the United Kingdom, Canada, and Israel.

This public relations tactic is becoming familiar territory for JUUL, whose official Instagram page is dominated by images of full-on adult adults, including testimonials from people like 68-year-old Kathy, a gray-haired woman named Barbara, and the rapper/actress Awkwafina, who, at 29 years old is young but no teen. The explicit focus on adults may be coming a little too late for the company, though, as it’s already in federal regulators’ crosshairs.

On September 13, Inverse reported that US Food and Drug Administration Commissioner Scott Gottlieb, M.D., announced that vaping had become an “epidemic.” Gottlieb noted that the FDA had issued 56 warning letters to retailers who illegally sold the devices to kids under 18 years old, and JUUL was specifically mentioned in his announcement. This week, the FDA also announced it had raided JUUL’s headquarters on Friday, seizing thousands of pages of documents. The operation was part of an investigation into whether JUUL has been marketing its products to children.

Scientists Want to Align Your Internal Clock Because Timing Is Everything


internal clock

In life, timing is everything.

Your body’s internal clock — the circadian rhythm — regulates an enormous variety of processes: when you sleep and wake, when you’re hungry, when you’re most productive. Given its palpable effect on so much of our lives, it’s not surprising that it has an enormous impact on our health as well. Researchers have linked circadian health to the risk of diabetes, cardiovascular disease, and neurodegeneration. It’s also known that the timing of meals and medicines can influence how they’re metabolized.

The ability to measure one’s internal clock is vital to improving health and personalizing medicine. It could be used to predict who is at risk for disease and track recovery from injuries. It can also be used to time the delivery of chemotherapy and blood pressure and other drugs so that they have the optimum effect at lower doses, minimizing the risk of side effects.

However, reading one’s internal clock precisely enough remains a major challenge in sleep and circadian health. The current approach requires taking hourly samples of blood melatonin — the hormone that controls sleep — during day and night, which is expensive and extremely burdensome for the patient. This makes it impossible to incorporate into routine clinical evaluations.

My colleagues and I wanted to obtain precise measurements of internal time without the need for burdensome serial sampling. I’m a computational biologist with a passion for using mathematical and computational algorithms to make sense of complex data. My collaborators, Phyllis Zee and Ravi Allada, are world-renowned experts in sleep medicine and circadian biology. Working together, we designed a simple blood test to read a person’s internal clock.

Listening to the Music of Cells

The circadian rhythm is present in every single cell of your body, guided by the central clock that resides in the suprachiasmatic nucleus region of the brain. Like the secondary clocks in an old factory, these so-called “peripheral” clocks are synchronized to the master clock in your brain, but also tick forward on their owneven in petri dishes!

Your cells keep time through a network of core clock genes that interact in a feedback loop: When one gene turns on, its activity causes another molecule to turn it back down, and this competition results in an ebb and flow of gene activation within a 24-hour cycle. These genes in turn regulate the activity of other genes, which also oscillate over the course of the day. This mechanism of periodic gene activation orchestrates biological processes across cells and tissues, allowing them to take place in synchrony at specific times of day.

The circadian rhythm orchestrates many biological processes, including digestion, immune function, and blood pressure, all of which rise and fall at specific times of the day. Misregulation of the circadian rhythm can have adverse effects on metabolism, cognitive function, and cardiovascular health.
The circadian rhythm orchestrates many biological processes, including digestion, immune function, and blood pressure, all of which rise and fall at specific times of the day. Misregulation of the circadian rhythm can have adverse effects on metabolism, cognitive function, and cardiovascular health.

The discovery of the core clock genes is so fundamental to our understanding of how biological functions are orchestrated that it was recognized by the Nobel Committee last year. Jeffrey C. Hall, Michael Rosbash, and Michael W. Young together won the 2017 Nobel Prize in Physiology or Medicine “for their discoveries of molecular mechanisms controlling the circadian rhythm.” Other researchers have noted that as many as 40 percent of all other genes respond to the circadian rhythm, changing their activity over the course of the day as well.

This gave us an idea: Perhaps we could use the activity levels of a set of genes in the blood to deduce a person’s internal time — the time your body thinks it is, regardless of what the clock on the wall says. Many of us have had the experience of feeling “out of sync” with our environments — of feeling like it’s 5:00 a.m. even though our alarm insists it’s already 7:00 a.m. That can be a result of our activities being out of sync with our internal clock — the clock on the wall isn’t always a good indication of what time it is for you personally. Knowing what a profound impact one’s internal clock can have on biology and health, we were inspired to try to gauge gene activity to measure the precise internal time in an individual’s body. We developed TimeSignature: a sophisticated computational algorithm that could measure a person’s internal clock from gene expression using two simple blood draws.

Designing a Robust Test

To achieve our goals, TimeSignature had to be easy (measuring a minimal number of genes in just a couple blood draws), highly accurate, and — most importantly — robust. That is, it should provide just as accurate a measure of your intrinsic physiological time regardless of whether you’d gotten a good night’s sleep, recently returned from an overseas vacation, or were up all night with a new baby. And it needed to work not just in our labs but in labs across the country and around the world.

A mismatch between our internal time and our daily activities may raise the risk of disease.
A mismatch between our internal time and our daily activities may raise the risk of disease.

To develop the gene signature biomarker, we collected tens of thousands of measurements every two hours from a group of healthy adult volunteers. These measurements indicated how active each gene was in the blood of each person during the course of the day. We also used published data from three other studies that had collected similar measurements. We then developed a new machine learning algorithm, called TimeSignature, that could computationally search through this data to pull out a small set of biomarkers that would reveal the time of day. A set of 41 genes was identified as being the best markers.

Surprisingly, not all the TimeSignature genes are part of the known “core clock” circuit — many of them are genes for other biological functions, such as your immune system, that are driven by the clock to fluctuate over the day. This underscores how important circadian control is — its effect on other biological processes is so strong that we can use those processes to monitor the clock!

Using data from a small subset of the patients from one of the public studies, we trained the TimeSignature machine to predict the time of day based on the activity of those 41 genes. (Data from the other patients was kept separate for testing our method.) Based on the training data, TimeSignature was able to “learn” how different patterns of gene activity correlate with different times of day. Having learned those patterns, TimeSignature can then analyze the activity of these genes in combination to work out the time that your body thinks it is. For example, although it might be 7 a.m. outside, the gene activity in your blood might correspond to the 5 a.m. pattern, indicating that it’s still 5 a.m. in your body.

Many genes peak in activity at different times of day. This set of 41 genes, each shown as a different color, shows a robust wave of circadian expression. By monitoring the level of each gene relative to the others, the TimeSignature algorithm learns to ‘read’ your body’s internal clock.
Many genes peak in activity at different times of day. This set of 41 genes, each shown as a different color, shows a robust wave of circadian expression. By monitoring the level of each gene relative to the others, the TimeSignature algorithm learns to ‘read’ your body’s internal clock. 

We then tested our TimeSignature algorithm by applying it to the remaining data, and demonstrated that it was highly accurate: We were able to deduce a person’s internal time to within 1.5 hours. We also demonstrated our algorithm works on data collected in different labs around the world, suggesting it could be easily adopted. We were also able to demonstrate that our TimeSignature test could detect a person’s intrinsic circadian rhythm with high accuracy, even if they were sleep-deprived or jet-lagged.

Harmonizing Health With TimeSignature

By making circadian rhythms easy to measure, TimeSignature opens up a wide range of possibilities for integrating time into personalized medicine. Although the importance of circadian rhythms to health has been noted, we have really only scratched the surface when it comes to understanding how they work. With TimeSignature, researchers can now easily include highly accurate measures of internal time in their studies, incorporating this vital measurement using just two simple blood draws. TimeSignature enables scientists to investigate how the physiological clock impacts the risk of various diseases, the efficacy of new drugs, the best times to study or exercise, and more.

Of course, there’s still a lot of work to be done. While we know that circadian misalignment is a risk factor for disease, we don’t yet know how much misalignment is bad for you. TimeSignature enables further research to quantify the precise relationships between circadian rhythms and disease. By comparing the TimeSignatures of people with and without disease, we can investigate how a disrupted clock correlates with disease and predict who is at risk.

Down the road, we envision that TimeSignature will make its way into your doctor’s office, where your circadian health could be monitored just as quickly, easily, and accurately as a cholesterol test. Many drugs, for example, have optimal times for dosing, but the best time for you to take your blood pressure medicine or chemotherapy may differ from somebody else.

Previously, there was no clinically feasible way to measure this, but TimeSignature makes it possible for your doctor to do a simple blood test, analyze the activity of 41 genes, and recommend the time that would give you the most effective benefits. We also know that circadian misalignment — when your body’s clock is out of sync with the external time — is a treatable risk factor for cognitive decline; with TimeSignature, we could predict who is at risk, and potentially intervene to align their clocks.

The 25 Most-Read Inverse Science Stories of 2017: Wild, Wonderful & Strange


This year will be remembered for its immense cultural and social upheavals, both good and unbelievably, Earth-shatteringly bad. But what appears to have remained consistent, at least judging by the science stories that Inverse fans read, interacted with, and shared, is a healthy curiosity about the the weird and wonderful, the science of our own bodies and minds, and scientific discoveries that push the limits of what we currently consider reality. That, and an obsession with whatever Neil deGrasse Tyson has to say about anything.

To celebrate a strange and sensational year in science, here are the 25 science stories that Inverse readers loved the most.

A Hamer individual from Ethiopia who took part in the study. Many alleles associated with light skin originated in Africa, not in Europe.

25. Genetics Researchers Just Disproved a Long-Held Racist Assumption

As racial tensions escalated this year in America and around the world, scientists found hard evidence that many of the assumptions people make about people with dark skin are completely, utterly unfounded. Many people still act as if people born with dark skin are less human, a behavior inherited from Middle-Age Europeans who believed the African people they encountered were not the same species as them. In October, scientists revealed they — and the people who continue to promote those beliefs — were completely wrong, showing that the human genes for dark and light skin all originated in Africa.

Read more about the racist theory debunked by science.

24. Drake Equation Revision Hugely Ups Odds of Intelligent Alien Life

The Drake Equation, written in 1961 for the first meeting of SETI (Search for Extraterrestrial Intelligence), is a seven-variable equation that calculates the odds that there are any active civilizations beyond Earth. In 2016, scientists decided it was a bit outdated, and so they updated it to include new data on exoplanets collected in the 50+ years since the equation was written. The new probability that there isn’t any other intelligent life out there is 10 billion trillion — making it extremely likely that there is something else out there.

Read more about your chances of meeting aliens in this lifetime.

23. Science Explains the Marijuana Hangover

The marijuana hangover — replete with headache, fatigue, fogginess, and dehydration, — has long confused pot users, who are more likely to associate the symptoms with alcohol. Scientists chalk the tired feeling up to the restless sleep that ensues when you get too high, and the dehydration you feel is caused by weed shutting down saliva production, which is what also causes the dreaded “dry mouth” while smoking.

Read more about the psychological and physical downside of a pot brownie binge.

22. Humans Have Been Having the Same Nightmare for Thousands of Years

Over the centuries, humans have come up with countless, often absurd, explanations for the phenomenon known as sleep paralysis. When it strikes, sleepers find themselves suddenly awake but unable to move, pinned to their bed as if a heavy weight is sitting on their chest. Scientists think the phenomenon has its roots in our brains, which actively paralyze us during REM sleep so that we don’t act out our dreams. If we’re suddenly interrupted during that phase, our brains sometimes “wake up” before our bodies do, leading to the terrifying nightmare-like experience.

Read more about sleep paralysis, which led to the evolution of the “Night Hag”.

Fossils found in submerged tunnels in Mexico might be the oldest human artifacts found in the Americas.

21. A Stolen Human Skeleton Might Be America’s Oldest

An investigation of the spoils from a plundered underwater cave in Tulum, Mexico, turned up an unlikely guest: the most ancient human skeleton ever found in the Americas. The Chan Hol II skeleton, which was first discovered in February 2012 and was actually stolen shortly after photos of it went public, was recovered by scientists who showed, using carbon dating, that it was 13,000 years old.

Read more about the very first Americans, who were actually in Mexico.

20. Diarrhea Is Evolution’s Immune System Drain-O

Poop will never not be funny for readers. It’ll also never not be interesting to scientists. This June, they discovered that diarrhea serves a critical purpose for animals, having evolved over millennia of evolution. As much as it sucks to get the runs while traveling or after eating an adventurous meal, having to rush to the can is much better than not getting diarrhea. The uncomfortable bowel movement, the scientists reported, is your body’s way of flushing out all of the potentially life-threatening toxins in your gut before they get into the rest of your body.

Read more about the biological reason diarrhea is good for you.

19. 20 Years After the Great Lego Spill, They’re Still Washing Ashore

In 1997, a container ship called the Tokio Express bound for New York was hit by a wave so huge that it knocked an enormous container full of 4.8 million pieces of Lego into the water. While at the time it didn’t seem like the miniature blocks would ever make it to their final destination, in July of this year residents of Cornwall, United Kingdom reported that the pieces are still washing up on the beach, suggesting there’s still a chance they may float to the other side of the Atlantic.

Read more about Lego pieces posing a hazard to barefoot British beach-goers.

18. Reddit Study on Ideal Penis Size Consistent With Dick Science

Despite all the changes that took place this year, our fascination with penis size did not waver. In July, the results of a small Reddit survey on penis size were presented in graph form, showing an upside-down U-shaped curve spanning lengths from four to ten inches. While this survey only incorporated self-reported data from 761 users, the results actually matched up well with what scientists already know about average peen size: like Reddit’s dicks, most dongs are about six and seven inches long and five to six inches around.

Read more about the average penis size and girth, on Reddit and elsewhere.

17. Neuroscience Reveals How the Brain Changes as it Watches Porn

We’re watching porn at record-breaking rates, and all that visual, er, stimulation has scientists wondering what it’s doing to us on an individual and a societal level. So far, we’ve learned that porn acts in many ways like a drug, causing our brains to release the pleasure-tr iggering neurotransmitter dopamine, and it may also activate the amygdala, the part of the brain linked to emotional behavior and motivation. Word’s still out on whether casual porn watching is problematic, but some scientists worry that very frequent porn viewing might be linked to certain psychological issues.

Read more about what all those late-night Pornhub visits do to your brain cells.

16. The Real Story Behind ‘Roanoke’ Is Creepier Than ‘AHS’

The sixth season of American Horror Story, centered on the historical real-life tragedy of the lost American colony at Roanoke, premiered in 2016, but it continued to intrigue Inverse readers well into 2017. Scientists have used lasers, magnometers, and radar to uncover rare objects that survived the 400 years since the colony was founded, but these still haven’t cleared up whether the colonists succumbed to disease, a violent uprising, or something even more sinister.

Read more about American Horror Story and the even more horrific Roanoke legend behind it.

15. China Transmits Data Into Space Using Quantum Entanglement

Around the world, scientists are making huge leaps in the field of quantum teleportation, which could revolutionize quantum computer security. China’s researchers are leading the pack, this year succeeding in transporting a quantum particle 870 miles into space — breaking the former distance record of 62 miles.

Read more about China’s supremacy in the quantum teleportation race.

14. Human Mini-Brains Growing Inside Rat Bodies Are Integrating

We’re living in the age of farmed organs, but scientists are still working out the kinks. These days, they’re growing human mini-organs inside animal bodies using stem cells that can be coerced into turning into livers, hearts, and brains. The brains are proving to be a bit problematic: in November, scientists reported that human brain cells grown inside rats are starting to transfer blood and nerve signals, giving the researchers pause: might these rat-brain hybrids become conscious?

Read more about whether hybrid rat-human brains will ever wake up.

13. Conspiracy Theorists Have a Basic Cognitive Issue, Say Scientists

Conspiracy theories abounded this year, which is perhaps not surprising, as previous studies have shown that increases in such beliefs tend to correlate with rising mistrust in authority structures. In October, scientists discovered what’s different about the way that people with these beliefs actually think: people who tend to believe in conspiracy theories, they explained, see patterns that don’t actually exist, and it’s this “illusory pattern perception” that causes them to believe in bizarre explanations for those imaginary patterns.

Read more about what’s different about the brains of conspiracy theorists.

12. Here’s Scientist Bill Richards’s Playlist for Tripping on Mushrooms

Psychedelic researchers have had a big year, using mind-altering drugs to treat psychological illness and thereby mitigating decades of stigma against them. Studies on the effects of the drugs, however, must be meticulously designed so that they will be considered legitimate, and so Bill Richards, Ph.D., a Johns Hopkins University researcher, used science to create a seven-hour playlist to maximize the experience of a psychedelic trip.

Read more about how to listen to music during a mushroom trip like a psychedelic scientist.

11. The Crazy Flat Earthers’ Theory That Trees Don’t Exist Isn’t Completely Crazy

The Flat Earth Movement drew criticism from Bill Nye, Neil deGrasse Tyson, and pretty much every other rational mind out there, but one of their bizarre theories actually kind of made sense. Kind of. Some Flat Earthers believe that what we call trees are actually just the tiny remnants of a world where trees were as wide as mountains and were so tall they scraped the sky. In the “no forests” theory, the present-day world represents the sad, small remains of what the Earth once was — which, as Inverse argued, is not altogether untrue.

Read more about the flat-Earther “no forest” theory and its somewhat compelling argument.

10. Indonesia Sea Monster Has Been Identified (It’s Not a Giant Squid)

In May, our appetite for the grotesque was satiated when news broke about a “sea monster” that had washed up on the shore of Indonesia’s Maluku Islands. This 50-foot-long blob of flesh was so badly decomposed that it was unidentifiable, and the giant bones that pierced through it only deepened its mystery. But about a week after it washed up, experts finally determined that it was the corpse of a type of baleen whale, misshapen because of the hot gases that bloated up inside it during decomposition.

Read more about the huge, dead sea animals mistaken for sea monsters.

9. Genetic Analysis Shows Early Humans Avoided Inbreeding, Incest

This year marked the penultimate season of Game of Thrones, which was as rife with incestuous themes as any other season. A study published in October echoed those themes, suggesting that our ancient human ancestors were a lot less genetically reckless than the inhabitants of Westeros. In the Science study, archaeologists showed evidence that humans buried together in Russia 34,000 years ago were no closer than second cousins, suggesting that even these humans knew not to bone their closest relations.

Read more about why incest is best left to the characters on Game of Thrones.

8. Scientists Discover Super-Massive Black Holes Just Outside Our Own Galaxy

We’re comfortable making movies about black holes because they’ve long seemed so far removed from real life, but a study published in January suggested that they’re a lot closer to us than we think. In an announcement from NASA’s Jet Propulsion Laboratory, scientists reported that they’d found evidence of two super-massive black holes in two of the Milky Way’s neighboring galaxies, 39 million and 176 million light years away from us.

Read more about your friendly neighborhood super-massive black holes.

7. Long-Term Marijuana Use Changes Brain at the Cellular Level, say Scientists

Weed smokers have long noticed, anecdotally, that long-term marijuana use tends to change people’s behavior, but it wasn’t until October of this year that scientists started to notice the cellular changes underlying those behavioral shifts. Using rats that were administered daily doses of marijuana, researchers publishing in JNeurosci showed that the GABA neurons in the brain were unable to properly regulate the amount of dopamine swimming around, causing abnormally drawn-out good feelings of reward — which is the mechanism that’s thought to lead to addiction.

Read more about marijuana’s long-term effects on your brain.

6. Upper Body Strength Is Biggest Factor in Male Attractiveness

Scientists behind a controversial study, published in December, used the results of a questionably designed experiment to argue that women, by and large, find strong-looking men attractive because those men look like they can fight. The ability to fight, in turn, is said to be appealing because ancient women needed men to protect them, and some vestige of that preference remains today. The researchers’ explanation, however, didn’t take into account the fact that perhaps the women involved in the study were not necessarily hard-wired to find those men attractive and rather were subject to a number of other influences, including their own personal choice.

Read more about why male attractiveness isn’t all about being swole.

5. Neil deGrasse Tyson Slams Flat Earth Theory With a Single Picture

Astrophysicist and notorious know-it-all Neil deGrasse Tyson could not resist sharing his thoughts on the rising Flat Earth conspiracy theorist movement, tweeting a sick eclipse-related riddle in November that was guaranteed to stump even the staunchest “globalist” truther.

Read more about Neil deGrasse Tyson’s admittedly clever addition to the flat Earth debate.

4. What Never Leaving Your Hometown Does to Your Brain

Written in 2015, this scientific investigation on the psychological effect of staying in one’s hometown remains a perpetual Inverse Science favorite. It’s not surprising, considering that migration rates among American youth are at a historic low and that more and more people are choosing to put down roots in the states where they were born.

Read more about the psychological effect of never leaving home.

3. Nanoparticle Scientists Warn Tattooed Folks: Ink Doesn’t Stay Put

A report from nanoparticle scientists in September, published in Scientific Reports, cast doubt on the permanence of ink tattoos, revealing that tiny particles from certain kinds of inks actually swim away from the skin and wind up in the lymph nodes. In particular, they found elevated levels of titanium dioxide, a white compound that’s often added to other pigments, in the lymph nodes of the four cadavers they used in their small study. It’s not clear yet whether the escaped compounds pose any danger to people with tattoos, but it’s certainly something scientists must consider.

Read more about the troubling impermanence of seemingly “permament” tattoos.

2. Surgeons Remove Over 28 Pounds of Feces From a Constipated Man

It was hard for readers to resist the horrific photo of an enormous colon, clogged with nearly 29 pounds of feces, cradled like a small animal in the arms of a surgeon. It belonged to a 22-year-old Chinese man in Shanghai who, suffering from an ailment called Hirschsprung’s disease, was unable to expel the majority of waste in his body for his entire life. He’s fine now, thanks to a team of surgeons who removed 30 inches of his swollen colon during a 3-hour operation.

Read more about what happens to a body when it never gets to poop.

1. Scientists Have Found the ‘Holy Grail’ of Physics, Metallic Hydrogen

Kicking off the year, in January, was a monumental announcement by Harvard physicist Isaac Silvera, Ph.D., who claimed to have created metallic hydrogen — a theoretical state of matter that scientists never thought would be possible. Silvera reported in Science that he had forced elemental hydrogen into that state using immense amounts of pressure and extremely cold temperatures, noting that, if produced in large enough amounts, metallic hydrogen could be used as a form of fuel for deep space travel. Other scientists in the narrow field, however, did not mince words when the time came to publicly criticize Silvera’s work.

Generic drugs: Review and experiences from South India


Abstract

The cost of pharmaceuticals, as a percentage of total healthcare spending, has been rising worldwide. This has resulted in strained national budgets and a high proportion of people without access to essential medications. Though India has become a global hub of generic drug manufacturing, the expected benefits of cheaper drugs are not translating into savings for ordinary people. This is in part due to the rise of branded generics, which are marketed at a price point close to the innovator brands. Unbranded generic medicines are not finding their way into prescriptions due to issues of confidence and perception, though they are proven to be much cheaper and comparable in efficacy to branded medicines. The drug inventory of unbranded generic manufacturers fares reasonably when reviewed using the World Health Organization-Health Action International (WHO-HAI) tool for analysing drug availability. Also, unbranded generic medicines are much cheaper when compared to the most selling brands and they can bring down the treatment costs in primary care and family practice. We share our experience in running a community pharmacy for an urban health center in the Pathanamthitta district of Kerala State, which is run solely on generic medicines. The drug availability at the community pharmacy was 73.3% when analyzed using WHO-HAI tool and the savings for the final consumers were up to 93.1%, when compared with most-selling brand of the same formulation.

Keywords: Drug availability, drug industry/legislation and jurisprudence, drugs, economic competition, essential medicines, generic*, generic medicines, global health, India, patents as topic/legislation and jurisprudence*, poverty, unbranded generics

Introduction

The World Health Organization (WHO) estimates that almost 30% of the world population lacks access to essential medicines and that the figure will rise to more than 50% in some countries of Africa and Asia.[1] The cost of the pharmaceuticals is the main factor that hampers access to medicines and the governments in poor countries seem to be doing very little to counter this problem. The public sector availability of essential medicines was less than 50% in most of the countries of Africa and Asia.[2] This is appalling in the face of increases in healthcare expenditure in most of the developing nations, mostly financed through secured loans by international development banks and consortia.

The situation in India is not very different than that of other developing nations. Healthcare expenditures have been growing in India, both in real terms and also when considered as a proportion of the Gross Domestic Product (GDP).[3] However, even with this recent increase in healthcare spending, India’s expenditure on health is nowhere near that of OECD (Organisation for Economic Cooperation and Development) nations.[4] The total public spending on healthcare in India accounted for only around 1.2% of GDP in 2012, with the per-capita spending on health around USD 160. This is a miniscule amount when compared against the OECD per-capita healthcare spending of USD 3,484 in 2012.[3,4] This shows that the healthcare spending in the country is set to rise further in the coming years and the healthcare industry is all set for a boom time.

The cost of medicines and pharmaceuticals as a percentage of total healthcare spending has also been rising worldwide.[5] It is the fastest-growing item in the healthcare budgets worldwide and it varies between 20-60% in various healthcare budgets of countries.[6] By 2020, the prescription drug market in United States of America is set to grow to USD 700 billion (B) and China will be USD 260 B.[5] Though no credible predictions about the Indian pharmaceutical industry are available, it is quite safe to assume that Indian pharmaceutical industry will also grow manifold. The growth of the pharmaceutical market worldwide and its increased share in total healthcare spending will reignite the age-old debate on how to balance the cost of innovation in drug research and universal access to the fruits of that research.[7]

Rise of Generics

The role of generic medicines in reducing the healthcare expenditure has been recognised for a long time. Multiple studies have proven that saving through substitution of originator brands by cheaper generic medicines, savings in the range of 10-90% can be achieved.[8] Most national governments have been encouraging the use of generic medicines worldwide and many healthcare systems have policies of substituting expensive branded original medications with generic medicines.[9] In the United States, generic substitution (GS) is an accepted practice and at the end of 2012, almost 80% of all the prescriptions were of generic medications. This has resulted in a substantial moderation of expenditure growth in widely used drugs and significant savings to the economy.[6] In the United Kingdom, GS is now a standard practice in hospitals operated by the National Health Service (NHS) and medical schools have included generic prescribing as a part of their medical training.[10]

In India, the procurement price of essential medicines is generally lower than the mean International Reference Pricing (IRP) but availability of these drugs in the public sector has always been a problem. The exorbitant cost of some of the commonly used medications in private pharmacies makes it inaccessible to majority of the poor.[11] Also, the difference between procurement prices and retail prices in case of some of the generic medicines, were as high as 28 times, which shows a very high margin of profit-taking in view of limited price control mechanisms.[11] It is in this light, that the government revised the National Pharmaceutical Pricing Policy in 2012. It gave methods to calculate ceiling prices for drugs which are under the National List of Essential Medicines (NLEM) which was modified in 2011. It gave a formula for deciding the ceiling prices for drugs under NLEM, using a market-based pricing (MBP) method, taking into account the prices of all manufacturers having a market share of more than 1% nationally.[12] The Drug Price Control Order of 2013 was a follow-up to the National Pharmaceutical Pricing Policy and gave the price ceiling for 348 drugs and over 600 formulations. However, the action was considered inadequate by many activists lobbying for cheaper drugs and they termed it as a sell-out to international pharmaceutical companies.[13]

Indian Pharmaceutical Industry

The multiplicity of brands and manufacturers makes it difficult to decipher the actual market dynamics and the structural issues in the Indian pharmaceutical industry. The complexity of the market and the intensity of the competition between companies in India have made the country a hub for manufacture of generic medicines, earning a sobriquet “pharmacy of the developing world.”[14] This, along with a favorable governmental stance has made India a powerhouse in this field, bringing it into direct confrontation with certain developed nations where most of the big multinational pharmaceutical companies are located[14] There have been many instances when the Indian Patents Office and the Supreme Court of India effectively used certain flexibilities of the Trade Related Aspects of Intellectual Property Rights (TRIPS) agreement of the World Trade Organization and also the safeguards embedded in the Indian Patents Act. The compulsory licensing of Sorafenib, a drug used in treatment of advanced liver and renal cancer and the rejection of patent application for Imatinib, a drug used in the treatment of leukaemia, were considered as landmark decisions by many state and non-state organizations involved in pharmaceutical sector.[15,16]

Considering the Indian scenario, we can divide the brands into innovator brands (IB), most-selling generics (MSG), and least-priced generics (LPG).[17] The IBs will be at the highest price point, followed by MSGs and LPGs. A new category of generic drugs known as unbranded generics (UB) are also coming into the market now. These drugs are usually manufactured by not-for-profit organizations or are subsidised by certain non-governmental organizations (NGO).[18] Though the price points of these different categories of drugs are different, their efficacies are comparable. This fact has been proved by multiple studies all over the world and it belittles the reasoning which goes behind differential pricing of the same drug.[19,20] Even though it has been proved that there is not much difference in efficacy between the above categories of drugs, physicians tend to prescribe drugs manufactured by highly-reputed companies. Their trust is often misplaced as most of these leading companies market drugs manufactured by less-known manufacturers.[18]

A Model Community Pharmacy: Experiences from South India

Pushpagiri Medical College, which is a teaching hospital in Kerala state of India partnered with a social organization, Bodhana Social Service Society, involved in poverty alleviation and income generation programmes, to start an urban health center with an objective to improve patient accessibility to cost-effective medical care. The urban health center serves a population of 10,000, spread over 5 municipal wards of Tiruvalla municipality and was intended as a model for cost-effective primary care. A comprehensive population survey was carried out before the start of the project and the health center started functioning in September 2014. As a part of the initiative, a community pharmacy was opened to stock unbranded generic drugs manufactured by two non-governmental organizations. Low-Cost Standard Therapeutics (LOCOST), Baroda and Comprehensive Medical Supplies India (CMSI), Chennai were the two NGOs providing us with the drugs which were needed at the community pharmacy.[21,22] The drugs were provided to us at a nominal cost, after we provided an undertaking that the Pushpagiri Medical College is a charitable institution with no intention of making profits. Also, the physicians working at the health center made a collective decision to prescribe all the drugs generically and the pharmacist was advised to dispense the cheapest generic brand.

The drug inventory available with these not-for-profit manufacturers were fairly comprehensive when reviewed using the World Health Organization-Health Action International (WHO-HAI) tool for quantifying availability of essential medicines.[23] The WHO-HAI tool is a validated method for measuring availability of drugs in a health system and includes 30 core medicines: 14 essential medicines for global burden of disease and 16 medicines specific to the WHO region [Table 1].[24]

Table 1

Drug inventory of LOCOST, Baroda and CMSI, Chennai: Review using WHO-HAI tool for WHO South East Asian Region

The WHO-HAI tool showed a drug availability of 73.3% for LOCOST, Baroda and 43.3% for CMSI, Chennai. This is much better when compared to drug inventory in public hospitals in other parts of India, assessed using the same methodology.[11] There are a multitude of companies and NGOs manufacturing UB medicines and the drug inventory of a health system can be made comprehensive through a mixed purchase model where procurement is done from multiple vendors.[23]

Similarly, unbranded generic drugs offered significant savings to the health system in terms of costs involved for procurement. When reviewed against the MSBs, UB medicines were costing only a fraction of the maximum retail price (MRP) of MSPs [Table 2].

Table 2

Comparison of drug prices of most-selling brands and their generic counterparts: drugs identified by WHO-HAI tool for WHO South East Asian Region[17,25]

The community pharmacy has been in operation since September 2014, and stocks over 120 formulations manufactured by unbranded generic manufacturers. In addition, it also supplies LSG to augment the drug inventory of the pharmacy. There is a family physician and a general practitioner who run the center, apart from regular specialist visits from Pushpagiri Medical College Hospital. The urban health center has an outpatient load of 20-25 patients a day within 6 months of starting operations. The staff from the center is providing services to 3 old-age homes and a few surrounding schools and the drugs from the community pharmacy is being used for free supply during the medical camps conducted by the department of community medicine.

The patients and the physicians have responded positively to this novel initiative and the general acceptability has been found to be high, though objective studies to assess the same are yet to be done. Some physicians have suggested replicating this model in other similar health initiatives also. The financial sustainability of the model is still unproven, and the urban health center along with the community pharmacy is being sustained with large subsidies provided by Pushpagiri Medical College and Bodhana Social Service Society. The cost of setting-up such a facility was around INR 500,000, which includes the furniture, basic medical equipment, basic lab accessories, and first round of procurement for the community pharmacy and is exclusive of the capital expenditure on the building. The average monthly expenditure in running the health center, has been around INR 150,000 a month, including salaries, cost of consumables and medicines and exclusive of building rent and depreciation. The income earned by the center is around INR 40,000, and there is an excess of expenditure over income to the range of more than INR 100,000 a month, which is subsidised by Pushpagiri Medical College and Bodhana Social Service Society. Both the organizations are charitable societies run by a prominent religious group and the subsidies are meant to further their commitment to social causes.

The community pharmacy concept faced the following key challenges:

  • Absence of intermediaries for drug procurement results in inordinate delays in transit, mainly on account of the tardy services rendered by private logistics companies
  • Advance payment in full has to be remitted to the bank accounts of these NGOs for supply of drugs, which goes against the standard practice of procurement followed in hospitals. This has been an issue with the internal audit department
  • The difference between procurement price and the MRP is minimal and this is causing worries of long-term financial sustainability of the community pharmacy model
  • Packaging of the drugs is unattractive in some cases, resulting in difficulty to convince patients about the efficacy of the drug
  • We have faced difficulty in convincing some of the specialist doctors on the quality of the drug, despite providing ample literature proving the efficacy of unbranded generic drugs.

The Way Forward

Many studies have revealed apprehensions among physicians in prescribing UB medicines to their patients. Most of these apprehensions are related to quality of the product and the fear of losing patients.[26] Along with these unfounded concerns, poor patient acceptability due to various issues like poor packaging, lack of brand promotion initiatives, etc., are affecting the extend of penetration of UB drugs in the country, even though India is becoming a lifeline for all developing countries in the supply of generic medicines.[27] The government and the policy makers in India and other similar developing countries should focus on building the confidence of physicians and the patients regarding unbranded generic medications. The demand side management should include a multifaceted approach in which issues of different stakeholders are addressed and affirmative actions taken in favour of unbranded generic medicine manufacturers.[27] Another important issue is concerning the inherent deficiencies and implementation status of the Drug Price Control Order of 2013. The said order has been criticised extensively for being myopic in its approach, as the number of formulations included is less than 20% of the whole pharmaceutical market. Also, it gave ample space for pharmaceutical companies to tweak their marketing strategies by focussing on formulations and dosages not covered by the Drug Price Control Order. It also leaves out the important area of fixed-dose combinations (FDCs), a potential loop-hole for the pharmaceutical companies to exploit fully. It is indeed distressing to note that more than 90% of the diabetic drug market is out of the purview of this order.[13] The policy makers in the country needs to get a realisation that the share of drugs in out-of-pocket expenditure (OPP) is around 80% in India and a tighter regulatory framework is needed to protect the consumers against exploitation.[28]

In the future, we intend to do a study on the perception about generic drugs, among the treating physicians and the patients who form the clientele of the community pharmacy. This can help us to understand the issues which affect the actual stakeholders and find means to improve the acceptability and penetration of generic medicines. Also, after the yearly financial audit, we plan to do a cost-benefit analysis to objectively analyse the efficacy of the model in monetary terms.

References

1. The World Medicines Situation 2011. The World Health Organisation. [Last accessed on 2015 Mar 2]. Available from: http://apps.who.int/medicinedocs/documents/s18772en/s18772en.pdf .
2. Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries: A secondary analysis. Lancet. 2009;373:240–9. [PubMed]
3. Health Expenditure, Total (% of GDP) | Data | Table. [Last accessed on 2015 Mar 2]. Available from: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS .
4. Microsoft Word-Briefing-Note-INDIA-2014-doc-Briefing-Note-INDIA-2014.pdf. [Last accessed on 2015 Mar 2]. Available from: http://www.oecd.org/els/health-systems/Briefing-Note-INDIA-2014.pdf .
5. Daemmrich A, Mohanty A. Healthcare reform in the United States and China: Pharmaceutical market implications. J Pharm Policy Pract. 2014;7:9. [PMC free article] [PubMed]
6. Hoffman JM, Li E, Doloresco F, Matusiak L, Hunkler RJ, Shah ND, et al. Projecting future drug expenditures–2012. Am J Health Syst Pharm. 2012;69:405–21. [PubMed]
7. Sax P. Spending on medicines in Israel in an international context. Isr Med Assoc J. 2005;7:286–91.[PubMed]
8. Cameron A, Mantel-Teeuwisse AK, Leufkens HG, Laing RO. Switching from originator brand medicines to generic equivalents in selected developing countries: How much could be saved? Value Health. 2012;15:664–73. [PubMed]
9. Hassali MA, Alrasheedy AA, McLachlan A, Nguyen TA, Al-Tamimi SK, Ibrahim MI, et al. The experiences of implementing generic medicine policy in eight countries: A review and recommendations for a successful promotion of generic medicine use. Saudi Pharm. 2014;22:491–503. [PMC free article][PubMed]
10. Duerden MG, Hughes DA. Generic and therapeutic substitutions in the UK: Are they a good thing? Br J Clin Pharmacol. 2010;70:335–41. [PMC free article] [PubMed]
11. Kotwani A, Ewen M, Dey D, Iyer S, Lakshmi PK, Patel A, et al. Prices and availability of common medicines at six sites in India using a standard methodology. Indian J Med Res. 2007;125:645–54.[PubMed]
12. Copy of f1.pdf – NPPPNotification.pdf [Internet] [Cited 2015 Mar 2, Last accessed on 2015 Mar 2]. Available from: http://www.nppaindia.nic.in/NPPPNotification.pdf .
13. Paying the Price – The Hindu. [Last accessed on 2015 Mar 2]. Available from: http://www.thehindu.com/opinion/op-ed/paying-the-price/article4912732.ece .
14. Kapczynski A. Engineered in India–patent law 2.0. N Engl J Med. 2013;369:497–9. [PubMed]
15. Bhaumik S. India’s rejection of Novartis’s patent is but a small step in the right direction. BMJ. 2013;346:f2412. [PubMed]
16. Lancet Oncology. Is India ready to lead the battle for fair access to medicines? Lancet Oncol. 2013;14:437. [PubMed]
17. Bhargava A, Kalantri SP. The crisis in access to essential medicines in India: Key issues which call for action. Indian J Med Ethics. 2013;10:86–95. [PubMed]
18. Amit G, Rosen A, Wagshal AB, Bonneh DY, Liss T, Grosbard A, et al. Efficacy of substituting innovator propafenone for its generic formulation in patients with atrial fibrillation. Am J Cardiol. 2004;93:1558–60. [PubMed]
19. Kesselheim AS, Stedman MR, Bubrick EJ, Gagne JJ, Misono AS, Lee JL, et al. Seizure outcomes following the use of generic versus brand-name antiepileptic drugs: A systematic review and meta-analysis. Drugs. 2010;70:605–21. [PMC free article] [PubMed]
20. Asia Pacific Ecumenical News-News. [Last accessed on 2015 Mar 2]. Available from: http://apenews.org/newsread.asp?nid=163 .
21. LOCOST: Medicines within the Common Man’s Reach | The Alternative. [Last accessed on 2015 Mar 2]. Available from: http://www.thealternative.in/business/locost- affordable-medicine-drugscommon-man-reach .
22. Where Are We Now: Assessing the Price, Availability and Affordability of Essential Medicines in Delhi as India Plans Free Medicine for All. [Last accessed on 2015 Mar 2]. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3733775 . [PMC free article] [PubMed]
23. Madden JM, Meza E, Ewen M, Laing RO, Stephens P, Ross-Degnan D. Measuring medicine prices in Peru: Validation of key aspects of WHO/HAI survey methodology. Rev Panam Salud Publica. 2010;27:291–9. [PubMed]
24. Drug Price List. List of Generic Names in Alphabetical Order. [Last accessed on 2015 Mar 2]. Available from: http://www.medindia.net/drug-price .
25. Generic Index | DrugsUpdate India. [Last accessed on 2015 Mar 2]. Available from: http://www.drugsupdate.com/generic/listing .
26. Waning B, Diedrichsen E, Moon S. A lifeline to treatment: The role of Indian generic manufacturers in supplying antiretroviral medicines to developing countries. J Int AIDS Soc. 2010;13:35. [PMC free article][PubMed]
27. Shrank WH, Choudhry NK, Liberman JN, Brennan TA. The use of generic drugs in prevention of chronic disease is far more cost-effective than thought, and may save money. Health Aff (Millwood) 2011;30:1351–7. [PubMed]
28. Thakkar KB, Billa G. Light at the end of the tunnel: The Great Indian Pharmacoeconomics story. Front Pharmacol. 2013;4:153. [PMC free article] [PubMed]
Source:www.ncbi.nlm.nih.gov

New Device Can Ease Chronic Pain Without Drugs, Thanks to Brain Stimulation


IN BRIEF

This new method of pain treatment can prevent risky side-effects such as addiction, dependence, and overdose-related deaths – and it does so using electricity.

OPIOID MEDICINES

Abuse of prescription pain killers or opioid medicines is common. But then again, how else can you treat chronic pain? Unfortunately, addiction is a terrible side-effect that can lead to overdose-related deaths.

But now a research team from the University of Arlington seems to have found a better and more efficient solution: Electrical stimulation.

By delivering electrical currents—which can block pain signals at the spinal cord level—into a deep, middle brain structure, it might be possible to treat chronic pain without the intervention of drugs. At the same time, the technique can spur the release of dopamine, which helps with the emotional distress typically associated with long-term pain.

A SHOCKING STUDY

“This is the first study to use a wireless electrical device to alleviate pain by directly stimulating the ventral tegmental area of the brain,” said Yuan Bo Peng, UTA psychology professor. “While still under laboratory testing, this new method does provide hope that in the future we will be able to alleviate chronic pain without the side effects of medications.”

Yuan Bo Peng, UTA Psychology Professor.

The team experimented with a custom-built wireless implant, which through electrical stimulation of the ventral tegmental area effectively reduced the sensation of pain, even blocking pain signals in the spinal cord.

This could greatly benefit the almost two million Americans who are addicted or dependent on opioid medicines. The Centers for Disease Control that 165,000 Americans died of opioid-related overdoses from 1999 to 2014.

“Until this study, the ventral tegmental area of the brain was studied more for its key role in positive reinforcement, reward and drug abuse,” said Peng. “We have now confirmed that stimulation of this area of the brain can also be an analgesic tool.”

Source:futurism.com

Here’s how long various drugs stay in your body.


Long after the initial effects of a drug wear away, its byproducts can linger in our blood, urine, and hair. And contrary to what many advertised drug tests might promise, not all substances leave their chemical signature in the body for the same amount of time.

How long drugs stay in your body

Top Ten Drugs That Cause Kidney Damage.


The damage to the kidneys can often be caused by the use of various drugs, so we tried to classify them today and reveal the top ten, at least according to types: antibiotic, analgesic, etc.

These are the top 10 drugs which damage kidneys:

  1. Antibiotics, such as ciprofloxacin, vancomycin, methicillin, sulfonamides.
  2. .Analgesics, like acetaminophen, as well as non-steroidal anti-inflammatory drugs (NSAID): ibuprofen, aspirin, naproxen, etc.
  3. Antiviral drugs, such as indinavir and tenofovir, both used to treat HIV, and acyclovir (brand name Zovirax) which is used in the case of herpes infection.
  4. Anticonvulsants, like trimethadione (brand name Tridione), used to treat seizures and other conditions, and phenytoin (brand name Dilantin).
  5. COX-2 inhibitors, such as celecoxib (brand name Celebrex). Two drugs, rofecoxib (brand name Vioxx), and valdecoxib (brand name Bextra) have been withdrawn from the market due to cardiovascular toxicity. They fall into the special class of NSAID which were intended to be safer for the stomach, but pose the same threat as other NSAIDs for kidney damage.
  6. Chemotherapy drugs, like quinine, interferons, cisplatin, pamidronate, carboplatin, tacrolimus, cyclosporine, mitomycin C, bevacizumab; and anti-thyroid drugs, like propylthiouracil, used in the treatment of an overactive thyroid.
  7. High blood pressure drugs, including captopril (brand name Capoten).
  8. Heartburn drugs of the proton pump inhibitor class, such as pantoprazole (brand name Protonix), omeprazole (brand name Prilosec), esomeprazole (brand names Nexium, Esotrex), lansoprazole (brand name Prevacid), and rabeprazole (brand names Rabecid, Aciphex).
  9. Lithium, used in the treatment of bipolar disorders.
  10. Rheumatoid arthritis drugs, such as infliximab (brand name Remicade); hydroxychloroquine and chloroquine, used in the treatment of malaria, rheumatoid arthritis, and systemic lupus erythematosus.

The Darknet: A secret world of snuff porn, drugs and guns


The-Dark-Web-entered-public-consciousness-in-2013-when-the-FBI-shut-down-Silk-Road-a-notorious-Darknet-website-that-that-allowed-anyone-to-buy-or-sell-drugs-Shutterstock-image

Videos of women torturing and killing animals such as cats and rabbits while simultaneously having sex, lethal weapons like the Walther PPK 9mm pistol being sold for a few Bitcoins, and groups that offer “rape and murder services”. This and much more are available in the Darknet, a shadowy part of the internet. You can’t access the Darknet through search engines like Google or Bing — and even the world’s most powerful security agencies can rarely crack its clandestine activities.

The Dark Web entered public consciousness in 2013 when the FBI shut down Silk Road, a notorious Darknet website that that allowed anyone to buy or sell recreational drugs, and made over $8 million a month. Silk Road founder Ross William Ulbricht aka Dread Pirate Roberts was sentenced to life imprisonment. The website allowed users to trade in Bitcoin, a crypto-currency completely disconnected from banks and thus offering completely anonymity.

https://i0.wp.com/www.hindustantimes.com/Images/popup/2015/8/silkroad2.jpg

Silk Road which was shut by FBI was notorious for selling illicit drugs.Indian cyber security experts believe criminals and terrorists in the country could already be using the Darknet for their activities because law enforcement agencies simply don’t have the wherewithal to track such activities.

“The Dark web is something that you can’t figure out unless you get into it yourself,” said senior technology journalist Prasanto Roy. “Unfortunately, our government is clueless.”

That may be true, but 8 of the 857 websites that the government asked ISPs to block recently are Darknet websites, characterised by their telltale .onion URLs. They include Agora Market, a Silk Road clone that also specialises in selling illegal drugs.

View image on Twitter

Pavan Duggal, cyber law expert and author of “Darknet and Law” said , “Law enforcement agencies and governments round the world don’t even acknowledge the presence of the Darknet because they are incapable of tracking activities.”

Just this week, the Interpol’s Cyber Research Lab formed a private dark web network to reverse engineer its technologies in order to better understand how criminals use it.

A study done last year by the University of Portsmouth’s computer science researcher Gareth Owens found that 80% of the traffic on the Darknet was to websites hosting child pornography. After a six-month study of the hidden services and websites that can be accessed through the Tor browser, Owen found that sites offering drugs and contraband made up the single largest category within the Dark Web.

 “Before we did this study, it was certainly my view that the Darknet is a good thing,” Owen was quoted as saying by the media. “But it’s hampering the rights of children and creating a place where paedophiles can act with impunity.”

Despite its depth and complexity, accessing the Dark Web is not very difficult. Most websites on the Darknet cover their tracks by using Tor, short for The Onion Router. People surfing the Darknet too can cover their tracks by using the Tor browser.

https://i0.wp.com/www.hindustantimes.com/Images/popup/2015/8/Weapons.jpg

Military-grade weapons being sold on the Darknet.Tor was initially a worldwide network of services developed by the US Navy that allowed people to anonymously browse the internet. Now, it’s an open-source project that hides a user’s identity on the web by encrypting a computer’s unique IP address and bouncing it across several volunteer servers, known as “nodes”, around the world so that it’s virtually impossible to trace the user.

A Kolkata-based professional, who used Tor to access sites on the Darknet while he was a student in Karnataka, said he used Silk Road and Evolution, a marketplace for contraband, to order banned drugs.

“These websites change their IP every 12 hours, and I found a blog that had the latest address. I then got some bitcoins from my Australian friend by transferring money to him through my bank account,” he said.

“I ordered twice from Darknet sites — once, blots of acid (LSD) and Ecstasy the second time. The acid was delivered in the form of small pieces of paper that had been dipped the drug and hidden within a stamp album. The ecstasy was delivered in a lipstick.”

https://i2.wp.com/www.hindustantimes.com/Images/popup/2015/8/Hitman.jpg

Professional hitman services being offered on the Darknet.People sometimes confuse the Darknet with the Deep Web, which too cannot be accessed by search engines. But a lot of the material on the Deep Web could be innocuous, such as the academic databases of universities and educational institutions, libraries or even material on internal servers of the Hindustan Times.

Despite its reputation, the Dark Web does have a few bright spots. During the Arab Spring, activists used Tor to anonymously pass on messages. Around the world, political dissidents and journalists have taken to the Darknet to cover their digital tracks for oppressive regimes.

“Indians are increasingly going on the Darknet after the revelations by (whistleblower) Edward Snowden about government surveillance and because non-state actors such as hackers groups could be watching their activities,” Duggal said.

“The Indian nation has not even woken up to the reality of the Darknet. We are still in the medieval age as far as our laws are concerned. We need to update tools and sensitise law enforcement agencies to this new challenge for India, which has the potential to destabilise security,” he added.

Pregnant Women May Overestimate Risk of Some Drugs


Pregnant women are often steering clear of drugs that might ease problems like nausea and urinary tract infections even though the treatments may be safe, a U.K. study suggests.

Researchers surveyed 1,120 women about common problems they experienced during pregnancy and whether they thought medications to treat these issues were harmful or beneficial.

Overall, about 76 percent of the women reported taking medication for at least one of eight common conditions during pregnancy including nausea, heartburn, constipation, colds, urinary tract infections, neck or pelvic pain, headaches and sleeping problems.

But for some problems, many women didn’t take medications, even when drugs might not be harmful or forgoing treatment might be dangerous, researchers report in the International Journal of Clinical Pharmacy, online May 30.

“Many women avoid medications as they fear harming the child,” said lead study author Michael Twigg, a pharmacy researcher at the University of East Anglia.

“We don’t want women to avoid medication and suffer unnecessarily from conditions that can be treated relatively easily,” Twigg added by email.

To understand how women think about medication use during pregnancy, Twigg and colleagues analyzed data from an online survey of women in England, Scotland, Wales and Northern Ireland.

Roughly 40 percent of the participants were pregnant when they completed the survey, while the rest had given birth within the previous year.

About 17 percent of the women reported having a chronic medical condition, most often asthma, allergies, depression, anxiety or thyroid issues.

For common pregnancy issues like nausea, sleep problems and constipation, women often avoided medication even though there are certain treatments available that are not considered harmful, the study found.

Even though about 79 percent of women experienced nausea during pregnancy, for example, only around 10 percent of them took medication.

Non-prescription anti-nausea drugs offer an example of how women may needlessly suffer and potentially allow small problems to escalate into bigger ones by avoiding treatment, said Angela Lupattelli, a study coauthor and pharmacy researcher at the University of Oslo in Norway.
“Nausea and vomiting can be very devastating for women, and it is very important that women do not become dehydrated or unhealthy as a result of pregnancy sickness,” Lupattelli added by email.

With sleep, 67 percent of women reported problems but only about 1 percent of them took drugs even though there are some nonprescription options that are not considered harmful during pregnancy.

Roughly 55 percent of women said they suffered from constipation, but only 19 percent of them turned to medication for relief. In this case, too, certain medications are thought to be safe during pregnancy.

Most worrisome, only about 65 percent of women who developed urinary tract infections during pregnancy took medications, a concern because these can escalate into kidney infections that can be life threatening for both mothers and their babies.

“Some untreated conditions such as urinary tract infections mentioned in the article, but also chronic conditions including depression, may cause severe complications, endangering the health of the mother and her unborn child,” said Marleen van Gelder, a pharmacy researcher at Radboud University Medical Center in the Netherlands who wasn’t involved in the study.

One problem, of course, is that drug trials exclude pregnant women for ethical reasons, limiting how much we know about whether many treatments are truly safe during pregnancy, van Gelder added by email.

Safety can also vary by trimester, and the benefits and harms of treatment may depend on the severity of women’s symptoms and other aspects of their pregnancy or medical history, ven Gelder noted.

One limitation of an online study is that the subset of women who choose to participate may not reflect the broader population, the authors note. The study team also lacked participants’ medical records or data on their drug use during pregnancy to assess how the severity of certain conditions might have influenced the women’s opinions about medication.

Women should ask a health professional when they have questions about drugs during pregnancy, Twigg advised.

“The consequences of not discussing appropriate use of medicines during pregnancy . . . can be serious,” Twigg said.

Tai Chi Resembles Drugs, Aerobics in Blood Pressure Lowering


Tai chi can lower blood pressure in older people as effectively as drugs or aerobic exercise, a new meta-analysis suggests.

The traditional Chinese discipline offers possibilities for older people who can’t or don’t want to exercise strenuously, said Linda Pescatello, PhD, from the University of Connecticut in Storrs.

“Tai chi is low intensity, it’s social, and this modality would be very attractive to older adults,” she told Medscape Medical News. This means that “they may be more adherent to it than to other forms of exercise.”

And tai chi can provide other benefits, such as improved balance, she added.

Dr Pescatello and coauthor Yin Wu, MA, also from the University of Connecticut, presented the finding here at the American College of Sports Medicine 2016 Annual Meeting.

It comes on the heels of results from the SPRINT trial, recently reported by Medscape Medical News, which showed that people 75 years and older with hypertension benefit when target systolic blood pressure is 120 mm Hg, which is lower than current guidelines.

But antihypertensive drugs can cause adverse reactions and aerobic exercise can be difficult or uncomfortable, especially for people with comorbidities, such as osteoarthritis.
To understand how effective an alternative tai chi could be, the researchers looked at the medical literature and searched for ways to combine the effects of many small studies.

They found 28 studies of tai chi that measured blood pressure, and judged them to be of moderate quality. The studies consisted of 1296 people who did tai chi and 919 people who served in nonexercise control groups.

In the pooled cohort, average age was 62.1 years, average body mass index was 25.8 kg/m², average systolic blood pressure was 135.5 mm Hg, and average diastolic blood pressure was 80.5 mm Hg. Sixty-two percent of the people were women, 56% were Asian, and 39% were white.

On average, tai chi was performed for 61.1 minutes per session, 2.9 times a week, for 20.6 weeks.

Systolic and Diastolic Blood Pressure Lowering

During this time, the average drop in systolic blood pressure was 6 mm Hg and in diastolic blood pressure was 3 mm Hg. “Reductions are comparable to first-line antihypertensive medications,” said Dr Pescatello. “They are consistent with what has typically been prescribed.”

The researchers also identified some trends in the data. First, they found that the reduction in systolic blood pressure was greater in people who performed tai chi more frequently.

When tai chi was practiced more than three times a week, the average reduction in systolic pressure was 9.6 mm Hg, when it was practiced three times a week, the average reduction was 5.3 mm Hg, and when it was practiced fewer than three times a week, the average increase in systolic pressure was 1.1 mm Hg (P = .002).

For studies in which blood pressure was a primary outcome, the average reduction in systolic blood pressure was 9.1 mm Hg, whereas for those in which blood pressure was a secondary outcome, the average reduction was 1.3 mm Hg (P < .001).

When the researchers combined those two findings, they showed that when blood pressure was a primary outcome, the average reduction in systolic pressure in people who performed tai chi more than three times a week was 13.6 mm Hg.

Average reduction in diastolic pressure was greater in people with higher resting pressure than in those with lower resting pressure (4.0 vs 0.1 mm Hg). And reductions in diastolic pressure were greater in studies at higher risk for bias.

The researchers point out that all the studies in their analysis defined tai chi as a low-intensity physical activity with elements of attention to breathing and relaxation. But most said nothing about the intensity of the tai chi exercises, the type of breathing or relaxation techniques, and how blood pressure was measured, which could be a limitation of the meta-analysis.

Tai chi might reduce blood pressure through a variety of mechanisms. For example, Wu explained, it could reduce stress or improve autonomic control.

This study “goes to show you don’t need to do crazy intense exercise to get cardiovascular benefits,” said Sarah Herrick, PhD, from the Massachusetts College of Liberal Arts in North Adams.

During the same poster session, she presented a study that showed that yoga decreases anxiety and that heart rate varies during bouts of yoga.

Yoga, too, has shown the capacity to lower blood pressure, Wu pointed out.

%d bloggers like this: